First PT

I had my first physical therapy appointment this afternoon. My ankle had been aching noticeably all morning, so I was really hoping that the appointment would result in my being in less, not more, pain. The physical therapist, Rita, seemed very competent and friendly, and like the docs, she was confident that this wouldn't take very long to heal. She emphasized that it would be important for me to do some cross-training over the next few weeks, something like swimming that would get my ankle moving a little without being hard on it. She said that this will strengthen the damaged tendons without damaging them more, and that needs to happen a little before I can start running again.

She did some diagnostic things and concluded that my tendonitis seems to be both a classic case and highly localized -- both good things. The flexibility of my injured ankle is only a little bit compromised, and the only thing I really couldn't do was stand tiptoe on it. Then she put an anti-inflammatory (dexamethasone) skin patch on the sore part of my ankle for about 15 minutes, had me do some stretches, and iced. My ankle felt good afterward and didn't start aching again for another few hours.

My homework is to do the stretches she showed me twice a day, keep icing in the mornings and evenings when I don't have the boot on, and keep taking a couple daily doses of ibuprofen. If I'm doing better (or at least not worse) on Friday when I have my next appointment, then she'll have me start the cross-training over the weekend. I'm glad everyone seems to think that I will be able to run again soon! I am following to the letter every instruction I've been given.

Boot update 2

I haven't actually weighed the boot, but if I had to estimate, I'd guess it weighs about as much as my cat, which is to say twelve pounds. So I am walking around with the equivalent of a cat on my leg. No wonder I've been so exhausted the last couple of nights.

Boot update

As of this morning, the unsecured internet connection I use at my house, which I previously could only get by placing my laptop on the floor next to the sliding glass door, seems to work from my desk. This is very convenient timing, since sitting on the floor with the boot is not really possible.

Booted

I was lucky enough to score a sports medicine appointment first thing this morning. After an awesome team of three doctors examined my ankle and asked me a zillion questions, they concluded that I probably have tendonitis (not bursitis). Still, it should have gotten better with the month I just spent resting and icing, and since it didn't, they felt more aggressive treatment was warranted. I explained that I'm about to start training for another marathon and that I'm moving away in three weeks, so it would be really nice if they could fix my ankle quickly please. The head doc said that he was confident that I could be pain-free within three weeks. That was great to hear! They decided to put me in a big boot, the kind you wear for a broken foot, for a couple of weeks and get me some physical therapy too. By immobilizing my ankle, the boot should allow the inflammation to go down. If I'm not pain-free within 1.5-2 weeks, they'll look at giving me a cortisone shot or something similar into the inflamed area to directly target the inflammation. They don't do cortisone as a first-line treatment because apparently there's some evidence that it can slightly increase the risk for tendon rupture.

I feel pretty good about this plan of action. The boot is a little tricky. It's very large (comes almost up to my knee) and heavy and I can only walk very slowly in it. Also, the sole of the boot is pretty thick, so I need to wear a shoe on my right foot that has a little elevation or else I'm uncomfortably lopsided. But I can deal with it for a couple of weeks, no problem, if it allows me to start running again! I don't think I will try to sleep in it, though.

I have my first physical therapy appointment on Wednesday; no idea what to expect. The docs also recommended that until the ankle is completely out of the woods, I adopt a sort of anti-inflammatory diet -- basically, don't eat sugar or things that my body will quickly convert into sugar or drink alcohol. They pretty much said that doing this might possibly help the inflammation go away more quickly, and in any case it certainly can't hurt me. I don't know if there's any evidence that a diet like this actually helps combat inflammation, but I see no reason not to try if there's even a chance it could have me up and running again sooner.

I'm back!

You didn't think you could get rid of me that easily, did you?

It has come to pass that I am going to run another marathon, and also that I am unable to run at the moment. Yes, this is about as contradictory as it sounds. After taking about three months off from running post-marathon, I started running again at the end of January and quickly developed an ankle problem. My left ankle would start hurting after about a half-mile of running -- not horrible pain, but enough that it wasn't fun to run. When it didn't go away on its own, I finally went to the sports medicine clinic at Campus Health Services on March 22. Three doctors examined my ankle and finally concluded that I probably had bursitis -- that is, inflammation of the bursa, which is the fluid-filled sac that provides a cushion between the Achilles tendon and the ankle bone. They explained that it's a self-perpetuating problem: the bursa gets a little bit inflamed from sudden overuse, causing it to get in its own way, causing more inflammation, etc. Their prescription: rest, ice, no stairs, should be better in a couple of weeks. I took them very seriously, and for the last month have followed their instructions obsessively, plus avoided sandals and taken two daily doses of ibuprofen to combat inflammation. Yesterday I got on a treadmill for the first time in a month to see how it's doing. The verdict: not well. It felt about the same as it felt a month ago. What a bummer! Tomorrow I'll call the sports medicine doc for another appointment to see what else they can do for me.

In the meantime, however, the idea of doing another marathon has started to sound good over the last couple of months. So, I entered the lottery to get into this year's Nike Women's Marathon, which is the same marathon I did last year. In order to get into this marathon without Team In Training, you have to be selected through a random lottery system, which they use for fairness because it's such a popular event. I found out on Friday that I got in! This is very exciting, because the marathon last year was such a great experience.

So, here's hoping that within a month, my ankle will be better and I can start training. My plan is to blog about my training like I did last year, because it was a great motivator and a fun way to keep track of what I'd done.